Bridging the Gap: How Translational Biology, Systems Research, and Homeopathy Can Uncover New Insights into Chronic Diseases

VARICOSE VEIN  AND ITS 

HOMOEOPATHIC MANAGEMENT

MEDICINES AND THEIR DIFFERENCIATING FEATURES

Medicine should be differentiated by its unique individualizing symptoms and thus the logical totality of each drug differs from one another. The most striking, singular, uncommon and peculiar (characteristic) signs and symptoms of the remedy are chiefly  considered here.

Pulsatilla nigricans

Particular symptom	Physical generals	Concomitant symptoms	Relationship
Varicose veins that develop during pregnancy. Swollen veins in the legs,  Legs feel hot and painful at night, with heaviness and weariness.  Pain worse when the legs are hanging down without support. Bluish hue with soreness and stinging pain; passive haemorrhage.  intense pain in the varicose	Chilly thirstlessness Dryness of mouth without thirst Pain appear suddenly leave gradually Symptoms ever changing Restless Feels better in open air.   modality stinging pain that worsen in hot weather < Warmth and keeping legs hanging. >cold application and open air.	Thick ,bland ,and yellow green discharge Gastric difficulty from pork, pastry Diarrhea changeable Menses suppressed by getting feet wet Flow more during day Mental generals Weep easily >consolation	Comply Kali m Lyc Sil Sul ac Kali m

Lachesis mutus

Particular symptom	Physical generals	Mental generals	Concomitant symptoms
Blue colour in area mainly on left side. blue-red swelling of the varicose vein Veins tend to bleed rather easily.	Hot patient Hot perspiration Hot flushes Climacteric ailments Sensitive to touch Intolerance to tightness Physical mental exhaustion Hemorrhagic diathesis Wants fanning from a distance Left side affinity	Long lasting grief Sorrow Fright Jealousy Great loquacity	All symptoms <after sleep Head ache <sleep Tonsillitis begin in left <hot fluids Constipation sensation of constriction of sphincter Menses at regular time All pains > by flow

LYCOPODIUM clavatum

Particular symptom	Physical generals	Mental generals	Concomitant symptoms
Drawing or tearing pains are felt in the legs, numb sensation< when the person is keeping still, legs may cramp at night in bed.  affecting the right leg; varicose of genital organs of labia during pregnancy, often of hepatic  origin;	Hot patient preferring warm drinks Right side affinity Easy satiety –a few mouthfuls fill up the throat	Ailments from anger vexation Irritable < contradiction Very sensitive ,cries even when thanked Fear of being alone	Tonsillitis  <cold drinks Excessive accumulation of flatulence Fullness not>by belching Red sand in urine Fullness esply in lower abdomen Digestive problems, sluggish liver function, and poor circulation.

Zincum metallicum

Particular symptom	Physical generals	Modality	Concomitant symptoms
Legs are fidgety and restless, with weakness in the muscles, must move them constantly  Crawling sensations, and a tendency to twitch.  Large varicose veins, with pain and soreness,< touch. Large veins with sweaty and restless feet Ulcers discharging thin, bloody, acrid. Feet sweaty and sore about toes	All complaints better when menses begin to flow, but return after flow ceases	< from wine < 5 – 7 pm > appearance of       eruptions, > during menses > discharge generally	Worse from alcohol, especially wine twitching of Single muscle all over the body. General trembling Brain or nerve power wanting Relationship Inimical : Cham and Nux should not be used before or after.

Vipera

Particular symptom	Physical generals	Concomitant symptoms
Veins are swollen, sensitive and feel as if they will burst unless the leg is elevated Inflammation of veins with great swelling , sensitive and bursting pain Burning sensation >by elevating parts Severe cramps in legs	Hemorrhagic tendency: blood black Symptoms periodic, Return every year Persistent edema with tendency to ulcers	Paralysis of foot extending upwards Enlargement of liver.

Fluoric acid

Particular symptom	Physical generals	Modality	Concomitant symptoms
Varicose veins little blue, collection of veins in small spots,  Varicose of legs tend to ulceration flat naevus. Varicose veins, often with small areas of “spider veins Varicose ulcer: obstinate ,long standing cases copius discharge<warmth; >cold ,violent pain like steaks of lightning, confined to small sports Itching especially in the orifices and in spots<warmth. Ulcer over the tibia Varicose vein following pregnancy	HOT PATIENT Feels as if burning vapors were emitted from pores. Offensive perspiration Degenerative process Syphilitic miasm Burning pain Crave cold water and is continually hungry	<warmth, <morning >cold >walking	All gone sensation in the stomach Morning diarrhea Caries and necrosis of long bone Relationship Complementary Coca , Sil. Inimical: Merc sol

Calc. Fluorata

Particular symptom	Physical generals	Modality
Varicose veins and their ulceration; enlarged, prominent veins Veins hard and knotty. It helps to restore the elasticity of the veins. Hard elevated edge of ulcer Secreacting thick yellow pus	Sensitive to cold Swelling or indurations of stony hardness Induration threatening suppuration	< rest <change of weather >warm applications

Calcarea carbonica

Particular symptom	Physical generals	Modality	Concomitant symptoms
varicose veins with painlessness   burning sensation in the varicose veins ; hurt while the person is standing or walking poor circulation, sole of the feet raw	Chilly patient The hands and feet remain cold and may have excessive sweating. weak or flabby muscles, cravings for sweets ,eggs, indigestible things The patient is malnourished but obese. Psoric miasm Increased ,cold, sore ,sweat Sensitive to cold, weakness	<from exertion <ascending <cold in every form <water washing <standing >dry climate >lying on painful side	Takes cold at every change of weather Profuse head sweat Frequent sore eructation Stiffness in all joints Relationship Antidote ;camph Nitric acid,Nux Complymentary Bell , Rhus , Lyco,Sil Incompactable Bry ,Sulphur should not be given after calcarea

Carbo vegetabilis

Particular symptom	Physical generals	Modality	Relationship
Poor circulation with icy coldness of the extremities, and mottled skin with distended veins and a bruised or “marbled” look, Legs feel weak and heavy often itch and burn. Veins are distended and itch especially in the evening and in bed <night Ulcers of varicose veins. Bluish discolouration	Old people with venous congestions Desire to be constantly fanned Craving for fresh or moving air for older people, or those who are slow to recover from an illness. Poor circulation. Putrid septic condition Burning sensation Cold sweat	Itching<in evening <warm in bed <warm damp weather. Evening, Cold >fanning	Comply: Kali carb Antidot: Ars ,Camph

Ars alb

Particular symptom	Physical generals	Mental generals	Concomitant symptoms
Varicose vein: itching ,burning, swelling , edema, <cold ,scratching Cramps in calves Trembling, spasm, weakness Varicose ulcers with offensive discharge Burning pain       < midnight, > from heat	Chilly Great thirst for cold water drinks often but little at a time Prostration <aftermidnight, 1-2am From cold drinks or food <lying on affected side >heat in general	Anxious, Anguish,Irritable Sensitive Restless Fear of death Mentally restless but physically too weak to move ,cannot rest in one place ,changing places continually, wants to be moved from one bed to another Anxiety<aftermidnight	Complaints return annually Diarrhea after eating and drinking, offensive,followed by prostration Breathing difficulty <after12pm ,midnight >sit or bent forward

Hamamelis virginica

Particular symptom	Physical generals	Modality	Associated symptoms
Varicose veins are large and sore, They tend to bleed easily. Pain is sore and bruises like, and the legs look bruised and purple.  stinging feeling may be felt in the irritated veins The muscles of the legs feel tired, heavy and are often cold. Inflammation of the veins (phlebitis) < from stepping sharply in a way that jars the leg.  Varicose veins in the thighs and legs that feels heavy and bruised.	Passive hemorrhages: profuse dark Weakness from loss of blood Bruised soreness of affected part Intense soreness	<warm , moist air Relationship Antidote: Arn Comply: Ferr	develop varicose veins in the genital area or have a tendency toward bleeding haemorrhoids chill in hips extending down the legs

Sepia officinalis

Particular symptom	Physical generals	Mental generals	Concomitant symptoms
Purple varicose veins that are congested and have lost their elasticity  For women with this type of varicose veins that deal with constipation frequently.	Chilly patient Offensive urine Pain are from below upwards Easily fainting Relationship Complementary: Nat mur,Phos , Nux Inimical : Lach ,Puls	Great sadness and weeping Indifferent Indolent Modality <evening ,left side After sweat >pressure, Hot application, Drawing limbs up	All gone feeling in epigastrium relieved by eating. Uterine prolapse >sit close, cross limbs Constipation, hard stool Sense of ball in anus not > by stool Ball sensation in inner parts

Ferrum metallicum

Particular symptom	Physical generals	Modality	Concomitant symptoms
Legs look pale but redden easily on the least pain or exertion. Walking slowly relieves the weak, achy feeling. Bleeding from varicose ulcer Restless when keeping still. Rending pain in limbs>moving quietly and gently	Hemorrhagic diathesis; blood light with dark clots, coagulates easily. Craves bread and butter Beer, tea ,Meat disagrees Oversensitive to pain Chilly patient	Always feels better by walking slowly about. < Night, at rest, while sitting still. sweating Pain and suffering come on during rest Rapid motion aggravates the complaints.	Anemic and weak Extreme paleness of face which become red and flushed on least emotion Every quick motion aggravates headache Rheumatism of left shoulder Relationship Antidote: Ars,Hep Comply :Chin,Alum, hamamel

Mercurius sol

Particular symptom	Physical generals	Modality	Concomitant symptoms	Relationship
Varicose ulcer with infection, pus, and foul-smelling discharge. Ulcers sting and burn and have a lardaceous base, with yellow green pus Edematous swelling of the feet	Profuse  sweat without relief Moist tongue with intense thirst Offensive breath Sensitive to heat and cold Syphilitic miasm	< night,  <perspiration < by warmth < lying on right side	Profuse offensive salivation Tongue large ,flabby with imprint of teeth; mapped tongue	Follows well: after Bell, Hep, Lach, Aur, Sulph but should not be given before or after Silicea.

Belladonna

Particular symptom	Physical generals	Modality	Relationship
Phlebitis Acute inflammation Red, hot, swollen, and tender varicose veins. Dry, hot burning Imparts a hot burning sensation to examining hand	Sensitive to drafts of air Pain usually in short attacks; Pain come suddenly last infinitely and cease suddenly	<touch, motion,after 3pm,night >rest	Complementary: Calcarea Antidotes :Camph; Coff; Opium;Acon Incompatible :Acet ac

Millifolium

Particular symptom	Physical generals	Modality	Relationship
Painful varicose veins occurring in pregnancy when PAINFUL Varicose ulcer: ooze a bright red blood	Hemorrhages: bright red, painless	<exertion <coffee	Follow well: after Acon, and Arnica in hemorrhages.

Arnica montana

Particular symptom	Physical generals	Mental generals	Concomitant symptoms	Relationship
varicose veins with sore and bruised feeling Bruising and swelling associated with trauma, surgery or overexertion.  Feeling as if one has been beaten.  bluish or blackish discoloration of the veins. Any exertion aggravates the trouble.	Everything on which he lies seems too hard; complains constantly of it and keeps moving from place to place in search of a soft spot Whole body over sensitive <rest lying down >motion	Says there is nothing matter with him Nervous Great fear of being touched or stuck by persons coming near him	Heat of upper part of body coldness of lower	Comply Acon Hyper Rhus tox

Causticum

Particular symptom	Physical generals	Mental generals	Concomitant symptoms
Varicose ulcer: Burning ,rawness , and sourness Pain in limb>warmth esply heat of bed Restless at night Itching in dorsum of feet Network of vein in skin	Rawness and soreness Chilly patient Preferring cold drinks <clear fine weather >damp, wet weather	Intense sympathy for the suffer of other Long lasting grief, sudden emotion Melancholy mood	Drooping of upper eye lids Constipation > stool passes better when standing Involuntary urination <coughing Menses only on day >on lying down Cough >drinking cold water >expiration

Graphites

Particular symptom	Physical generals	Modality	Relationship
Varicose veins with itching. Cramping pains in the legs. Varicose ulcer: oozes a watery ,transparent, sticky fluid. burning pain with numbness Old ulcer with proud flesh and burning ,itching and stinging, ulcer with indurated base and margins	Chilly patient Sensitive to draft of air Suffering part emaciate Fidgety while sitting at work Offensive sweat and breath Craving for air Weakness The patient is usually obese, constipated and may have  skin problems	< At night; <before midnight < during and after menses Motion increases all symptoms except the numbness	Complementary: Caust , Hep,Lyc Graphites follows well: After Lyco,Puls; after Calc in obesity of young women with large amount of unhealthy adipose tissue;follows Sulpher in skin affections

Apis mellifica

Particular symptom	Modality	Physical generals	Relationship
Leg swollen shiny Sensitive, sore, stinging pain Feet swollen stiff Edematous swelling ,Red rosy hue Extreme sensitive to touch and general soreness.	< heat, touch, pressure, late in afternoon, >Open air, cold bathing	Thirstlessness Right side affinity Extreme sensitive to touch Pain :Burning Stinging, Sore; suddenly migrating from one part to another	Complemetery Nat mur Inimical Rhus tox

Sulphur

Particular symptom	Modality	Physical generals	Relationship
Bluish spots, swollen varicose vein. Painful fatigue Restless leg and feet, cramps Burning pain in soles at night Itching, burning, Pruritus especially from warmth. phlebitis	<Scratching and Washing < When standing, Warmth in bed, 11 am, night > dry warm Weather, lying on Right Side.	Burning Pain, Itching Standing is the worst position	Complimentary Psorin, Acon

Thuja Occidentalis-

An anti-sycotic Medicine, to remove the miasmatic tendency in cases where the blow outs have appeared. There may be muscular twitching, weakness. Pain in heels. Increased perspiration, Sensitive to touch, Coldness of one side, Chilly Patient, < night, 3am, and 3 pm, Cold

Silicea terra –

In painless varicose ulcer. Cramps in calves and soles. icy cold and sweaty feet. Offensive sweat on feet, varicose ulcer - with Offensive pus. Long lasting suppuration. Itch only in day time and evening. <  Lying on left side, Cold > Warmth.

Ferrum phos:-

 Varicose and haemorrhoids in young people; stool hard & difficult followed by backache throbbing pain.

Bellis perennis –

Varicose veins that are bruised and sore, walking is difficult

Aconite napellus   :

This remedy may be beneficial in cases that are usually brought on by long periods of standing, painful, uncomfortable, restless legs as well as a feeling of fatigue.

SELECTION OF POTENCY

Psoric stage.

In the psoric stage where the objective symptoms are absent, and the patient complaints of only the subjective sensations like aching pain, burning sensation, muscle cramps; then it indicates only functional disturbance and no well-marked pathology is established. In this condition start the treatment with higher potency like 200.

Sycotic and Syphilitic stage.

In the sycotic or syphilitic stages, where the valvular incompetency and varicose ulcer are present, the pathology is well evident. Start the treatment with 30th potency and follow up to higher and higher potency as and when indicated.

The susceptibility of the patient

The more similar the remedy, the more clearly and positively the symptoms of the patient take on the peculiar and characteristic form of the remedy, the greater the susceptibility to that remedy and the higher the potency required; that is when the symptoms of a case clearly indicate one remedy, whose characteristic symptoms correspond closely to the characteristic symptoms of the case, we give the high potencies- 200^th , 1M or higher.

The nature and intensity disease.

In case of varicose ulcers with intense pain, we have to first aid and ameliorate the pain as soon as possible, in such case go for low potency (30^th ). Another advantage of 30^th potency is that its action starts and stops rapidly and so if the selected remedy was wrong, it will be soon evident and we can go to the next indicated remedy based on present totality. At the same time if the case is not yet progressed much, and the symptoms are of only mild character associated with the symptoms in other systems then go for totality of symptoms ,and prescribe in high potency.

The stage and duration of the disease.

In long standing case of varicose vein and venous ulcers, with well-marked venous incompetency, think of low potency. On the other hand recently occurred aching pain due to prolonged standing is considered as functional disorder and gives higher potency.

Selection of dose

For this purpose it is most convenient to employ fine sugar globules of the size of poppy seeds, one of which imbibed with the medicine and put into the dispensing vehicle constitutes a medicinal dose, which contains about the three hundredth part of a drop, for three hundred such small globules will be adequately moistened by one drop of alcohol. The dose is vastly diminished by laying one such globule alone upon the tongue and giving nothing to drink.

Aphorism 285 foot note,Organon of Medicine

Dispensing one dose-

To prepare the pellets to give to patients, one or a couple of such little pellets are put into the open end of a paper capsule containing two or three grains of powdered sugar of milk; this is then stroked with a spatula or the nail of the thumb with some degree of pressure until it felt that the pellet or pellets are crushed and broken then the pellets will easily dissolve if put into water.

The Chronic diseases their peculiar nature and their homoeopathic cure 

Frequency  of repetation

NEVER REPEAT YOUR REMEDY  SO LONG AS IT CONTINUES TO ACT

Every perceptibly progressive and strikingly increasing amelioration in a transient (acute) or persistent (chronic) disease, is a condition which, as long as it lasts, completely precludes every repetition of the administration of any medicine what so ever, because all the good the medicine taken continues to effect is now hastening towards its completion. Every new dose of any medicine what so ever , even of one last administered, that has hitherto shown itself to be salutary, would in this case disturb the work of amelioration.

Aphorism 245;6^thedition ; Organon of Medicine

The dose of the same medicine may be repeated several times according to circumstances, but only so long as until either recovery ensues, or the same remedy ceases to do good and the rest of the disease, presenting a different group of symptoms, demands a different homoeopathic remedy.

 Aphorism 248 Organon of Medicine

Frequency of repetition also depends on the potency selected. For 30^th potency we have to give at least 1week to finish it action. For 200^th potency we should wait at least 2 weeks. 1M potency has action lasting as for more than 1 month. As improvement is there; any repetitions is contraindicated.

Diet and Regimen

Considering the minuteness of the doses necessary and proper in homoeopathic treatment we can easily understand that during the treatment everything must be removed from the diet and regimen which can have any medicinal action, in order that the small dose may not be overwhelmed and extinguished or disturbed by any foreign medicinal irritant^.1

^{§ 259, Organon of Medicine.}

 Coffee; fine Chinese and other herb teas; beer prepared with medicinal vegetable substances unsuitable for the patient’s state; so-called fine liquors made with medicinal spices; all kinds of punch; spiced chocolate; odorous waters and perfumes of many kinds; strong-scented flowers in the apartment; tooth powders and essences and perfumed sachets compounded of drugs; highly spiced dishes and sauces; spiced cakes and ices; crude medicinal vegetables for soups; dishes of herbs, roots and stalks of plants possessing medicinal qualities; old cheese, and meats that are in a state of decomposition, or that passes medicinal properties (as the flesh and fat of pork, ducks and geese, or veal that is too young and sour viands), ought just as certainly to be kept from patients as they should avoid all excesses in food, and in the use of sugar and salt, as also spirituous drinks, heated rooms, woolen clothing next the skin, a sedentary life in close apartments, or the frequent indulgence in mere passive exercise (such as riding, driving or swinging), prolonged suckling, taking a long siesta in a recumbent posture in bed, sitting up long at night, uncleanliness, unnatural debauchery, enervation by reading obscene books, subjects of anger, grief or vexation, a passion for play, over-exertion of the mind or body, especially after meals, dwelling in marshy districts, damp rooms, penurious living, etc. All these things must be as far as possible avoided or removed, in order that the cure may not be obstructed or rendered impossible. Some of my disciples seem needlessly to increase the difficulties of the patient’s dietary by forbidding the use of many more, tolerably indifferent things, which is not to be commended.

^{§ 260 Fifth Edition foot note, Organon of Medicine}

Maintaining cause

The factor which leads to occurrence, continuation and progress of the disease should be first eliminated. Prolonged standing and lack of physical exercises are the maintain cause for the persistence of varicose vein. In cases where the maintaining factor has progressed the disease beyond a limit, then even after the removal of the maintaining cause, the effect still persists as pathological alternation, this cannot be reversed back to normal without the administration of medicinal agent.

“Hence the careful investigation into such obstacles to cure is so much the more necessary in the case of patients affected by chronic diseases, as their diseases are usually aggravated by such noxious influences and other disease-causing errors in the diet and regimen, which often pass unnoticed.”

§ 260 Fifth Edition

“Because the organism is endowed with either a faculty of provisionally supplementing to a limited extent one stimulus by another, or with a kind of elasticity,- a power of enduring for a certain time a disturbance of equilibrium of these stimuli, and of rebounding to normal performance of function again so soon as the natural proportion of the stimuli is restored or the deficiency made up….

But, in the organism this elasticity has its limits. This “vis medicatrix naturae” is not inexhaustible. If the due proportion of the stimuli remain too long disturbed, the functions of the organism become permanently deranged –at least, to such an extent, that no restoration of the balance of the stimuli will cause a return to their normal performance. The functions are and remain deranged –disease has occurred; or, if we choose to call every direction from a state of equilibrium disease, then we may say that now disease ensues has no tendency to revert to health without the intervention of some extraneous in Substance foreign to the organism and different from the general stimuli aforesaid.”

Homoeopathy the science of therapeutics By C. Dunham

OBSERVATION AND FOLLOW UP

As far as homoeopathic method of treatment is concerned, a homoeopath should use his intellect and discrimination more in the observation and determining the curative effect of medicine in the follow up rather than selection of medicine in the first visit.

The physician should have the clear idea regarding when to repeat or change the medicine, when to change the potency and most importantly when to wait to finish the action of previous medicine.

After the first prescription physician  should observe and note down

1.     Which of  the symptoms got ameliorated

2.     Which one of the previous symptoms disappeared

3.     Whether there is aggravation of previous symptoms

4.     Whether there is appearance of old symptoms

5.     Or appearance of new symptoms

Signs of improvement in a case after the administration of a Similimum

1.     An improvement in the state of mind and disposition.

2.     No appearance of any, unusual symptoms [new symptoms].

3.     Diminution of old symptoms or none of the old symptoms are worse.

The state of aggravation in the patient is apprehended if he points out some fresh accidents and a symptom of importance even though he might assure his physician that he feels better.

Hahnemann's Observation

           But should we find, during the employment of the other medicines in chronic (psoric) diseases, that the best selected homoeopathic (antipsoric) medicine in the suitable (minutest) dose does not affect an improvement, this is a sure sign that the cause that keeps up the disease still persists, and that there is some circumstance in the mode of life of the patient or in the situation in which he is placed, that must be removed in order that a permanent cure may ensue.  

Aphorism 252,  Organon of Medicine by Samuel Hahnemann

Among the signs that, in all diseases, especially in such as are of an acute nature, inform us of a slight commencement of amelioration or aggravation that is not perceptible to everyone, the state of mind and the whole demeanour of the patient are the most certain and instructive. In the case of ever so slight an improvement we observe a greater degree of comfort, increased calmness and freedom of the mind, higher spirits-a kind of return of the natural state. In the case of ever so small a commencement of aggravation we have, on the contrary, the exact opposite of this: a constrained, helpless, pitiable state of the disposition, of the mind, of the whole demeanour, and of all gestures, postures and actions, which may be easily perceived on close observation, but cannot be described in words.

Aphorism 253, Organon of Medicine by Samuel Hahnemann

But even with such individuals we may convince ourselves on this point by going with them through all the symptoms enumerated in our notes of the disease one by one, and finding that they complain of no new unusual symptoms in addition to these, and that none of the old symptoms are worse. If this be the case, and if an improvement in the disposition and mind have already been observed, the medicine must have effected positive diminution of the disease, or, if sufficient time have not yet elapsed for this, it will soon effect it. Now, supposing the remedy is perfectly appropriate, if the improvement delay too long in making its appearance, this depends either on some error of conduct on the part of the patient, or on the homoeopathic aggravation produced by medicine lasting too long (aphorism 157), consequently on the dose not being small enough.

Aphorism 255, Organon of Medicine by Samuel Hahnemann

On the other hand, if the patient mention the occurrence of some fresh accidents and symptoms of importance-signs that the medicine chosen has not been strictly homoeopathic-even though he should good-naturedly assure us that he feels better, [‘as is not infrequently the case in phthisical patients with lung abscess’ in the Sixth Edition] we must not believe this assurance, but regard his state as aggravated as it will soon be perfectly apparent it is.

Aphorism 256,  Organon of Medicine by Samuel Hahnemann

Dr. Kents Observation

• ·        In the follow up if there is long time aggravation followed by amelioration of the symptoms and slow improvement then it indicates marked pathologically advanced case.  In case of valvular incompetency in perforator veins  complicated to venous ulcers , deep vein thrombosis and in case of secondary varicose vein due to mechanical pressure from tumors of pelvis [when no venous cause was identified],  the period of aggravation will be longer but general improvement in health in the curable cases will be manifested . 
• ·        If the aggravation is quick, short, and strong with rapid improvement, then it indicates that the choice of medicine was exactly correct [similimum]. But the potency selected was slightly higher than needed. This observation is specifically seen when there no secondary cause behind varicose vein and case pertain to only venous cause [primary varicose vein].
• ·        If there is no aggravation at all, and rapid, gentle and permanent cure of the patient occurs. Then it indicates that the choice of remedy and the potency was exactly correct. This is the ideal homoeopathic cure which occurs mainly in functional disorders without any tendency to organic disease. This observation may be seen in C₀  stage of varicose vein or that develop due to the morphological factor [prolonged standing] .
• ·        If the amelioration occurs in the first 3 or 4 days followed by aggravation, then it indicates that the medicine selected was only partially similar. Medicine selected was similar to most pronounced symptom but don’t cover the whole case. In such case retake the whole case, consider the general symptoms of the patient and select the similimum according to the present totality. This is also seen in pathological advanced complicated case of varicose vein where palliation is only possible.
• ·        If the amelioration is too short followed by aggravation immediately after administration of remedy, then it indicates the interference with the action of remedy by the patient unconsciously or deliberately and intentionally. Or this observation is seen when the action of the remedy on the vital force is exhausted. Amelioration is too short in cases of varicose vein were pathological changes have taken place.
• ·        In some cases there may be appearance of old symptoms, or the symptoms which was suppressed in the past, or symptoms of any condition maltreated in the past, or appearance of any symptoms that you have enquired in the history of past illness. If such old symptom appears in the follow-up visit then this indicates the cure is going in the correct direction and the remedy selected was exactly similimum covering the root constitution or the miasm of the patient. Sometimes the whole case becomes clear after appearance of the previously suppressed skin symptoms.

FOLLOW UP BY  ANTIMIASMATIC MEDICINE

A patient who has recovered from an acute disease by the use of these non-antipsoric medicines, should never be regarded as cured; on the contrary, no time should be lost in attempting to free him completely, by means of a prolonged antipsoric treatment, from the chronic miasm of the psora, which, it is true, has now become once more latent but is quite ready to break out anew; if this be done, there is no fear of another similar attack, if he attend faithfully to the diet and regimen prescribed for him.

 Concept extracted from Aphorism 222